Introduction:Intussusception is the commonest cause of bowel obstruction in infancy and childhood. The present study deals with the presentation, management and outcome of children presenting with intussusception at the Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and Methods: Forty-seven children presenting at Department of Surgery, B. P. Koirala Institute of Health Sciences over a 5-year period were prospectively studied. Results: There were 27 (58.6%) males and 20 (41.4%) females, with male-to-female ratio of 1.4:1. The ages ranged from 2 months to 13 years, with a median age of 30 months. The mean duration of presentation was 10.7 ± 30.66 days (range 1-180 days). The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass was seen in 10 (21%) of the cases. Surgical exploration was done in 42 (89.3%) patients. The commonest lead point was non-specific hyperplastic lymph nodes, occurring in 22 (54.3%), followed by idiopathic variety (16.6%), Meckel's diverticulum (9.5%), ileocaecal junction (7.1%), submucous lipoma (4.7%), Non-Hodgkin's lymphoma (4.7%), appendix (2.3%) and a mucosal polyp (2.3%). Overall mortality rate was 6.3%. Conclusion: The presenting age group and the time of presentation are higher than other studies. The mortality rate of 6.3% is comparable to other studies in the developing world. Earlier presentation could have avoided surgery, with a higher possibility of cases being managed conservatively.

Background: External hernias are relatively simple diseases in themselves to treat; however, complications developing in them, such as irreducibility, obstruction and strangulation, may present as a life-threatening one. Objective: To study the characteristics of these patients and identification of risk factors that may predict development of these complications would help place the patient in a high-risk group and subsequent intervention. Methods: It is a prospective descriptive study in patients presenting to Surgery Department of BPKIHS, Dharan, Nepal with a diagnosis of complicated external hernias from December 2009 to July 2011. Results: There were a total of 63 patients including 53 males (84.1%) and 10 females (15.8%). The average age of the patients was 49.23+21.4 years (range 10 days-85 years). The average duration of hernia was 6.36+6.57 years (range 5 hours -30 years). The median duration of complications was 2 days (range 5 hours-15 years). There were 7 mortalities (11.11%). The morbidity rate was 33.33% (21 cases). Risk factors identified for mortality were age >65 years (p=0.004), inguinal hernias (p<0.001), presence of co-morbid diseases (p<0.001), presence of strangulation (p=0.007) and bowel resection (p<0.001); and for morbidities were type of hernia (p<0.001), presence of co-morbid diseases (p=0.013), and bowel resection (p=0.002). Conclusion: Elderly males with co-morbid diseases with inguinal hernia and with strangulation and needing bowel resection are most likely to die from more complications. Such patients when seen in the outpatient department should be given priority admission and taken up for early elective surgery.

Abdominal cocoon is an uncommon peritoneal condition characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions. Only few cases of this disease have been reported in world literature. The etiology of this condition is unknown, and most often it is found in adolescent girls from tropical or subtropical countries, and usually diagnosed incidentally on exploration. Surgery (membrane dissection and extensive adhesiolysis) is the treatment of choice. Here, we report a case of abdominal cocoon in a 20-year-old male patient, with a brief review of the literature.

Postoperative idiopathic intussusception is considered to be a distinct entity, and has been reported following different operations. We present a 45-year-old female with postoperative ileoileal intussusception following a transverse loop colostomy for sigmoid volvulus, in which there was a kinked loop of bowel forming the lead point. The pathogenesis and literature review of this disorder is discussed.